A suture tensioning device can be employed to tension a suture during a surgical procedure, such as a tissue fixation procedure that repairs or replaces a tendon or ligament with a graft to bone. A suture tensioning device provides additional leverage to tighten the suture without damaging the suture, the bone or the tissue. A previous suture tensioning device includes a cannulated tube, and a suture is fed through at least a portion of the cannulated tube.